• Clare L Gillies, Alex V Rowlands, Cameron Razieh, Vahé Nafilyan, Yogini Chudasama, Nazrul Islam, Francesco Zaccardi, Daniel Ayoubkhani, Claire Lawson, Melanie J Davies, Tom Yates, and Kamlesh Khunti.
• Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester, LE5 4PW, UK.
• J R Soc Med. 2022 Apr 1; 115 (4): 138144138-144.

ObjectiveTo assess the association between household size and risk of non-severe or severe COVID-19.DesignA longitudinal observational study.SettingThis study utilised UK Biobank linked to national SARS-CoV-2 laboratory test data.Participants401,910 individuals with available data on household size in UK Biobank.Main Outcome MeasuresHousehold size was categorised as single occupancy, two-person households and households of three or more. Severe COVID-19 was defined as a positive SARS-CoV-2 test on hospital admission or death with COVID-19 recorded as the underlying cause; and non-severe COVID-19 as a positive test from a community setting. Logistic regression models were fitted to assess associations, adjusting for potential confounders.ResultsOf 401,910 individuals, 3612 (1%) were identified as having suffered from a severe COVID-19 infection and 11,264 (2.8%) from a non-severe infection, between 16 March 2020 and 16 March 2021. Overall, the odds of severe COVID-19 was significantly higher among individuals living alone (adjusted odds ratio: 1.24 [95% confidence interval: 1.14 to 1.36], or living in a household of three or more individuals (adjusted odds ratio: 1.28 [1.17 to 1.39], when compared to individuals living in a household of two. For non-severe COVID-19 infection, individuals living in a single-occupancy household had lower odds compared to those living in a household of two (adjusted odds ratio: 0.88 [0.82 to 0.93].ConclusionsOdds of severe or non-severe COVID-19 infection were associated with household size. Increasing understanding of why certain households are more at risk is important for limiting spread of the infection.

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